HomeMy WebLinkAboutMortgage_Bottoms (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
r_" Std Form 43709(R13/10-15) -
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be h7ed in person or by mail - D• -. . ►,a`1^
Frog Dates: 1) Real Property.Must be completed and dated to the calendar year for which the deduction is sought.
Must be fried or postmarked with the County Auditor or County Recorder of the county when the property is 4 •- n Are •
located on or before January 5 of the immediately succeeding calendar year. Recorder
2) Mobile/Manufactured Homes not assessed as Real Property.Must fie with the County Auditor of the
Nc • k V _ s •:
where the property is boated during the twelve(12)months before March 31 of each year the deduction is
See reverse lLsid.3 c e for additio nal ionaali nstructions and qualifications.
li coc �O�.Taxing Ke /legal desa on
Record
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ntheee
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Assessed value of oral property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessor td dale.corer year assessment date,cement year date of appficativnn ^ legal or equable owner?
fi alp ❑ yes D No
If no,what is his/her exact share of interest? If owned with someone other than sprnico,indicate with whom
If name on record is different than that of applicant,indicate below Is property in question:Annually Assessed
Real Property ❑ Annuaey Assessed
Mobke Home(IC 61.1-7)
Name of mortgagee or contract seller 5
Address of umrtgages or contrail seller(number end street,city,state,and ZIP code) -
•
Name of assignee or other owner or holder of mortgage '
Address of assignee(mmDerand street,city,state,and Z/Paxle)
L a1- S- 9 Y �
Does t that axing D Has this dedudbn been requested If yes,sate amount of deduction
other c on property for
ux IMin pA al) A. r 5 current yeah ❑Yes ❑No
A perm a balance on the person's mortgage or contract indebtedness that is recorded in the county
rewrite recorded in the county recorders office)that is the basis for the deduction.
•
I(p— 40251 COUNTY AUDITOR •
Deduct
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20 20 20 20 20
Signature of County Audi a Canty Data(month,day,year) •
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contact buyer of the aforementioned property on date application is filed.
( sirdemkkownert he name) Date(month,day,year)
l` 1� n 7140 14 [3oTTO M S
Fug:resident address of applicant(number and street,city,state,and ZIP code)
T` 8t E 900 ) 3p/Fe/D. -nu J7L / 3
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,slate,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 510,000.